Quality of Diet and Cardio-Metabolic Outcomes in Native American Adolescents Participating in the Together on Diabetes Home-Visiting Program

Abstract Objectives 1) Examine the impact of the Together on Diabetes (TOD) program on diet quality using the Alternative Healthy Eating Index (AHEI); 2) Determine the association of diet quality with outcomes of cardio-metabolic health (systolic and diastolic blood pressure, hemoglobin A1c, and zBMI). Methods TOD was a 12-month home-visiting diabetes prevention/management program, evaluated using a pre/post study design, conducted in four rural, reservation-based Native American communities in the southwestern United States. Participants were 10 to 19 years of age and were identified as pre-diabetic, T2DM or “at risk” based on body mass index (zBMI) and a qualifying laboratory test. Diet information was collected via an adapted Block food-frequency questionnaire (FFQ). Diet quality was calculated using the AHEI, broken into quartiles based on distribution of the sample. Changes in AHEI-score and associations with cardio-metabolic measures were tested, over time, using adjusted linear mixed effects models. Results The majority of the sample (n = 240) completed the FFQ at baseline and reported an average energy intake of 2016.18 Kcal/day (±1260.45) and AHEI-score (Range: 0–110, higher = better diet quality) of 47.37 (±7.36), indicating low diet quality. At 12 months follow-up, there was a reduction in calories (m = –345.75 Kcal/day (P < 0.001)), sugar-sweetened beverages (SSB) (m = –2 fluid ounces/day (P = 0.032)), red-processed meat (m = –1.5 ounces/day (P = 0.008)), and sodium (m = –650.37 mg/day (P < 0.001)) but no change in overall AHEI-score (p-value = 0.600). At baseline, the HbA1c of diabetic participants with the highest quartile AHEI-score was significantly lower (m = –1.43% (p-value = 0.048)) than those with the lowest quartile score. At 12-months the systolic blood pressure of participants with the highest quartile AHEI-score was significantly lower (m = –5.71 mm Hg (p-value = 0.038)) than those with the lowest quartile score. Conclusions Despite stable AHEI-scores during follow-up, there were improvements in diet quality domains most likely to be associated with poor cardio-metabolic health (e.g., overall calories, SSB consumption, and sodium intake). Home-visiting programs, like TOD, are promising interventions for decreasing dietary intake of poor quality foods. Funding Sources The Bristol Meyers Squibb Foundation funded the TOD Program.